Valvular heart disease Flashcards
What is aortic regurgitation
reflux of blood from the aorta through the aortic valve into the left ventricle during diastole
What can be the reasons for Aortic regurgitation
Valve disease
Aortic root disease
What valve disease can cause aortic regurgitation
Rheumatic fever
Infective endocarditis
Connective tissue disease (RA/SLE)
Bicuspid aortic valve
What aortic root disease can cause aortic regurgitation
Aortic dissection
Spondylarthropathis
Hypertension
Marfan’s
Ehler-Danlos syndrome
Syphilis
What are the symptoms for aortic regurgitation
Significant symptoms occur late do not develop until LV failure develops
Angina
Dyspnoea
What murmur is a sign for aortic regurgitation and how is it best heard
High pitched early diastolic murmur best heard at the left sternal edge in fourth intercostal space when patient is leaning forward and breath is held in expiration
What are other signs for aortic regurgitation
Collapsing pulse
Apex beat is displaced laterally and downwards and forceful in quality
What are the investigations for aortic regurgitation
ECG
CXR
Echocardiogram key for diagnosis and severity
CMR - secondary
Cardiac catheterisation - secondary
What is the medical therapy for aortic regurgitation
Treat underlying cause
If acute may need vasodilators and in tropes
ACE inhibitors for chronic AR and HF
Beta-blockers may slow aortic dilation in Marfan’s patients
What is the surgical management of aortic regurgitation
Indicated in symptomatic and asymptomatic patients when LV function begins to deteriorate
-> Valve replacement
What is aortic stenosis
Aortic valve is too small, narrow or stiff resulting in obstruction of blood flow from left ventricle to aorta during systole
What is the reason for Aortic stenosis in young patients
Usually from congenital bicuspid valve (birth defect)
What is the reason for Aortic stenosis in old patients
Usually from calcifications on aortic valve or rheumatic heart disease is next most common
When do symptoms start and what are they in aortic stenosis
Usually no symptoms until aortic stenosis is moderately severe then:
Exercise-induced syncope, angina and dyspnoea develop
describe the murmur that is a sign for aortic stenosis
Ejection systolic murmur best heard at 2nd right intercostal space right sternal edge (aortic area)
Radiates to carotids
What are the investigations for aortic stenosis
CXR
ECG
Echocardiogram
If indicated: CMR, cardiac CT
What is the management of aortic stenosis
Conventional valve replacement (preferred)
Patients that don’t tolerate operation under anaesthesia: TAVI
What is Mitral Regurgitation
Occurs when blood leaks back through mitral valve during systole
What can be the causes for Mitral regurgitation
Primary valve disorder
Secondary to left ventricular dysfunction
What are examples of primary valve disorders
Infective endocarditis
MI causing valve prolapse
Rheumatic fever
What are symptoms of Mitral regurgitation
Dyspnoea
Peripheral oedema
Fatigue
What murmur is a sign for mitral regurgitation
Pan-systolic murmur best heard at apex (5th intercostal space in left midclavicular line) radiating to the axilla
What is another sign for mitral regurgitation
Displaced apex
What are the investigations for mitral regurgitation
CXR
ECG
Echocardiogram-conform diagnosis and severity
If indicated - CMR, coronary angiography
